Homestead_Lichte H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715 _
I. SELLER(S)IGRANTOR(S)
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Seller 1—Name as it appears on conveyance document Seller 2-Name as appears on conveya •1.cuk ID
Southern Indiana Home Investments LLC
Address(number and street) Address(number and street)
2416 Shannon Street DEC 3
City,State,and ZIP Code City,State,and ZIP Code 2024
Washington, IN 47501
Country --- Country I BSON COUGO"''Q
E-mail Address Telephone Number E-mail Address -46,j)7-6/4:-
Undertuber
penalties of perj , hereby ertify this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as
required by law,and"= pr='ared i •ccordance with IC 6-1.1-5.5.A person who knowingly and Intentionally falsifies the value of transferred
real property,or o .s o 'al- • •ny Information required to be provided,commits a Level 5 felony.
Signature of Seller li Signature of Seller
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Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance document
Mark Lichte
Address(number and street) Address(number and street)
427 S Gibson Street ,.
City,State,and ZIP Code City,State,and ZIP Code
Oakland City, IN 47660 •, '
Country Country '
CV
,.' Pursuant to IC 6-1,1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary 0 3.Homestead
OLI r—i residence? ❑ Ey 4.Solar Energy Heating or Cooling System
Q 2.Does the buyer have a homestead to be vacated 0 [� 5.Wind Power Device
l ❑ for this residence?If yes,provide address: ❑ 6.Hydroelectric Power Device
Q Address(number and street) 0 Er-7.Geothermal Energy Heating or Cooling Device
3Z4 S Gibsci, 54r.
i 1 City,State,ZIP code,and County
tt ?cinteirovt 'Iy-161-70, is,65on . a6.-1tk_IchZo( -- Un I •ol --004-
O Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
I as required by law,and is prepared in accordance with IC 6-1.1 S.S.A person who knowingly and intentionally falsifies the value of
(--/ transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
information,SSN/Driver's License/ID/Other Number is necessary only ifa Homestead Deduction is being filed.)
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